Table 2.

Meta-Analysis Results, Osteoporosis Treatment (Pharmacotherapy) Outcome

Type of quality improvement strategy	Included studies	Summary estimate of relative risk (RR)a (95%CI; I2 valueb)	Summary estimate of risk difference (RD)a (95%CI; I2 valueb)
Meta-analysis findings for studies in which all patients had recent or prior fracture
Fracture liaison service/case management	Jaglal 2012,(39) Majumdar 2007,(46) Majumdar 2011(48)	1.94 (1.15–3.27; I2=62.1%)c	0.20 (0.01–0.40; I2=84.2%)c
Multifaceted intervention targeting providers and patients	Bessette 2011,(25) Cranney 2008,(32) Feldstein 2006,(36) Kilgore 2013,(42) Leslie 2012,(44) Majumdar 2008,(47) Roux 2013d(56)	1.95 (1.50–2.55; I2=67.0%)e	0.12 (0.06–0.17; I2=85.8%)e
Orthopedic surgeon or fracture clinic initiation of osteoporosis evaluation or management	Miki 2008,(52) Rozental 2008(57)	1.99 (1.19–3.32; I2=0.0%)	0.26 (−0.09–0.61; I2=75.5%)
Patient education and/or activation	Danila 2016,(34) Davis 2007,(35) Gardner 2005(37)	1.64 (0.65–4.15; I2=66.8%)e	0.21 (−0.10–0.52; I2=93.3%)e
Meta-analysis findings for studies that included patients without prior fracture
Multifaceted intervention targeting providers and patientsf	Ciaschini 2010,(27) Solomon 2007,(60) Solomon 2007(61)	1.44 (0.90–2.30; I2=81.7%)g	0.02 (−0.02–0.06; I2=85.6%)e
Patient education and/or activationh	Cram 2006,(30) Heyworth 2014,(38) Solomon 2007(61)	0.93 (0.82–1.06; I2=0.0%)e	−0.01 (−0.02–0.00; I2=0.0%)e
Pharmacist initiation of screening	McConaha 2014,(49) Yuksel 2010(66)	2.62 (0.76–9.00; I2=0.0%)	0.05 (−0.02–0.12; I2=46.3%)

^aRandom-effects meta-analysis using DerSimonian and Laird method; results for intervention compared to comparator/control

^bPercentage of variation across studies attributable to heterogeneity

^cSignificance of meta-analysis findings sensitive to removal of Majumdar et al. 2007⁽⁴⁶⁾ or Majumdar et al. 2011⁽⁴⁸⁾ studies in influence/sensitivity analysis

^dFor Roux et al. study⁽⁵⁶⁾, results from both intervention groups combined were used for meta-analysis

^eSignificance of meta-analysis findings robust to removal of individual studies in influence/sensitivity analysis

^fLafata et al. study⁽⁴³⁾ could not be included due to lack of clarity on 2×2 table values from reporting in paper. Contacted author but numbers were still unclear. However, if we assume all randomized patients in Lafata et al. study⁽⁴³⁾ included in osteoporosis treatment analysis, meta-analysis results for RR would be significant, but RD meta-analysis results would remain not significant.

^gSignificance of meta-analysis findings sensitive to removal of Solomon et al. 2007 study⁽⁶¹⁾ in influence/sensitivity analysis

^hLafata et al. study⁽⁴³⁾ could not be included due to lack of clarity on 2×2 table values from reporting in paper. Contacted author but numbers were still unclear. However, if we assume all randomized patients in Lafata et al. study⁽⁴³⁾ included in osteoporosis treatment analysis, meta-analysis results for RR and RD would still not be significant.